20505 85TH PL W20505 BSTH PL W
STREET FILe
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Division of R6tiitst4bn
3011 Rockefeliir Avo -Alpine 9422 1
Ettrettj Washington
Permit . Pia. /l1 %y Date
APPLICATION FOR � $ Oft RECOPI$TftiR'T SMIAGE VMW
Address .2.0
Address of Proposed site = 0tS- (1Y' t Y.1 /v '>
Legal Description: Lot Block Addition _,i a� -e-�
Type of useo . of bedrooms Lot size
Septic tank Capacity JQ ! -gallons. Disposal field length
Sanitarian s Sketch:
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Date Inspected by Installer�a
Approval_Matled- to
Rec. ~
40
•
•__ $5.00 fee for permit
SN01101:ISH HEALTH DISTRICT•
3011 Rockefeller Avenue
Everett, Washington
Phone ALpine 9.2061
LOT APPROVAL SHEET
NAME e /'/ • /7/ C /! S ADDRESS /0. 0 . BOX 'Z
ADDRESS OF PROPOSED BUILDING
LEGAL DESCRIPTION: LOT 26 BLOCK ADDITION pi h e IFPVq ,e
TYPE OF USE NO. OF BEDROOMS 3 SIZE OF LOT /03' X Z D O
SOURCE OF DRINKING WATER: PUBLIC SUPPLY PRIVATE WELL
A SURFACE DR IMAGE
1. Is disposal field site well drained?
2. 'Any water course (s,Atea%*drainage ditch etc.) through site? yt�
B. TOPOGRAPHY
1. Any heavy slopes in field area? -)U-
2. Will present topsoil in field area be removed or graded before field tiles
are installed? %ram
3. Will any fill material be used in the disposal field site?it♦-If yes, how much
C. SOIL CONDITIONS
1. Has a hole at least 4 feet deep been dug itlathe disposal field area to deter-
mine the type of soil present?
2. After hole is dug record the soil conditions at the following depths.
(Record as sand, gravel, caly, packed sand, loam, etc.
12 inches v L. 30 inches Ste-n
18 inches_'5 36 inches ;5 et
24 inches $a>iW 48 inches S
4. Any ground water encountered before reaching a depth of 4 feet?
If so, at what depth?
D. WATER TEST
A simple water test will show how well this soil will drain or percolate water.
To perform this test:
1. Dig a hole at least 36 inches deep. Use a shovel or post hole digger -
size of hole makes no difference - only depth.
2. Fill hole with water. Now let all water run our of hole. This soaks the
ground and will give a more accurate reading.
3. Again pour water in hole to a height of 12 inches from the bottom. Let
water run out until there is just 6 inches from bottem left in hole.
4. Note how many minutes it takes for this last 6 inches to,_oeep_away. 3 $'
5. Divide this time by 6 to obtain the rate per inch.
6. Date water test was performed. &S.� 3 %9P6 ;2--
I hereby certify the above information to be correct and the above tests were per-
formed by me as prescribed.
Signed
Address
NOTE: A septic tank permit is issued on the basis of the above information. If
there are any changes or alteration in the above stated soil conditions it may
result in the installation being rejected at the time of inspection.